Patient Financial Serv Rep 4
Job DescriptionAs a Patient Financial Services Representative 4, you will perform the duties for a Patient Financial Services Representative 3 and be responsible for the timely and accurate editing, submission and/or follow-up of assigned claims. To help achieve our mission, you will process claims for multiple payer types (i.e. Commercial, Managed Care, Blue Cross, Medicare, Medicaid, etc.) and ensure that all assigned claims meet clearinghouse and/or payer processing criteria. Your ability to ensure appropriate follow-up on assigned work lists while meeting all departmental productivity and quality review standards is of vital importance. Informing management of issues and potential resolutions regarding problems with the claims process is expected. Providing support, education and guidance to team members while performing duties, as assigned, in the absence of the supervisor or manager is required.
- Ensures that all clean claims are submitted the day they are received, submitted via the appropriate medium and with all required attachments. Serves in the place of the supervisor or manager in their absence.
- Resolves complex issues either through individual actions or by coordinating information/action of other team members, Patient Accounts staff, other hospital departments or at the payer level. Seeks assistance from supervisor when needed.
- Ensures that claims are reviewed, corrections are identified/made or resolutions are initiated within 24 hours from the date that claims are received. Identifies the need for and provides support/guidance to other team members to promote their efficiency and productivity.
- Handles complex and/or highest dollar accounts while providing appropriate follow-up based on established protocol or SRGs.
- Ensures appropriate and timely documentation of all account activity while appropriately handling all correspondence within 48 hours of receipt.
- Documents activity in HealthQuest and TRAC and ensures that documentation is professional, appropriate, accurately depicts actions performed and is in accordance with departmental quality review standards.
- Works payer response reports and rejection reports while ensuring they meet departmental productivity and quality review standards. Maintains knowledge of payer requirements, UB-92 standards, system (Hospital, clearinghouse, payer) functionality and hospital policies and procedures.
- Takes direction from management to resolve issues in addition to providing support, education and guidance to team members. Performs duties, as assigned, in the absence of the supervisor or manager.
AA degree or additional three years’ experience appropriate to the position under consideration
Three years of experience in revenue cycle, finance, customer service, or data analytics
CPAT certification within one year of start date
Working keyboard skills.
Knowledge of Microsoft Word and Excel.
Working knowledge of Microsoft Office products.
Ability to think critically to identify trends and resolve accounts independently.
Working knowledge of Patient Accounting system(s)